TABLE 3.
Participant quotes
| Theme | Quote | Author | |
|---|---|---|---|
| 1. Disruptions due to COVID‐19 | “Feeling frustrated because I've been learning how to control the bulimic symptoms and normally able to manage them. Yet the change in routine (or lack of) and general stress/anxiety is unsettling it and I noticed my thoughts and behaviors changing” (participant details not provided) | Branley‐Bell and Talbot (2020) | |
| “Without structure and focus (and meaning) of uni [university] and friends and having a life that feels worth living, now it's just old habits and misery” (participant details not provided) | McCombie et al. (2020) | ||
| “My routine has gotten lost, which tampers with my sleep, which in turn tampers with my ability to follow my meal plan” (30, female participant, anorexia nervosa) | Hunter and Gibson (2021) | ||
| “For me, it was like, I go to my therapist, I leave my problems there, I go home. […] Now, many things take place in my room, and I have all these problems, these conversations right on the spot. This felt strange for me at the beginning” (participant details not provided) |
Zeiler et al. (2021) |
||
| 2. Variability in the improvement or exacerbation of symptoms | 2.1 Negative outcomes of the COVID‐19 pandemic | “I have been in recovery from AN [anorexia nervosa] and BN [bulimia nervosa] for about 2 years now, and ever since this whole isolation thing started, my symptoms have come back, and worsened almost immediately” (participant details not provided) | Richardson et al. (2020) |
| “The pandemic has increased my self‐harm, as I've felt so restricted by the government in terms of what I can do to deal with my feelings (i.e., initially – only exercise once a day, not able to exercise with anyone else). Using healthy means to deal with difficult feelings (i.e., go for a walk, meet a friend for coffee) have been more limited and so it is really easy to go back to unhelpful ways of coping such as self‐harm” (female participant, anorexia nervosa) | Vuillier et al. (2021) | ||
| “My ED feels more valuable to me than ever. It is the only constant in what feels like a completely upside down and scary world, it is my only locus of control” (participant details not provided) | Branley‐Bell and Talbot (2021) | ||
| “With the recent quarantine, I am unable to work out the same… just running and doing as much as I can. I've found my body changing in ways I am very uncomfortable with. I'm waking up daily weighing myself, logging my food, and checking my Fitbit constantly. I recently started staring in the mirror more and despising the person who looks back” (participant details not provided) | Nutley et al. (2021) | ||
| “Times when I would normally kind of be doing something potentially social or something like that over the weekend… Obviously with more free time, I might have gone back to see my parents–that […] feeling, of like, existential loneliness felt incredibly desperate and really quite painful. But it was… It came in bursts to begin with, and I think as lockdown has gone on, it's that feeling of real painful loneliness” (25, female participant, White, anorexia nervosa) | Brown et al. (2021) | ||
| “Everything is dramatically worse because of being home all the time. I have constant access to all of my food and my scale and everything to evaluate where I'm at and to facilitate eating” (participant details not provided) | Frayn et al. (2021) | ||
| “I definitely walk past the mirror more often and do some body checking” (participant details not provided) | McCombie et al. (2020) | ||
| “In the initial stages of the pandemic it seemed pointless to try to manage my ED [eating disorder]. The stress and anxiety regarding the future meant that I did not see the point in investing energy in my own physical or mental health” (female participant, binge eating disorder) | Vuillier et al. (2021) | ||
| “It's sort of paradoxical because on one hand, I was really anxious realizing it was going to stall my progress but then on the other, I was really anxious that it would stall my disordered behaviors, so it's been quite complex” (27, female participant, anorexia nervosa) | Hunter and Gibson (2021) | ||
| “COVID‐19 has affected my general mental health quite a lot through isolation and anxiety. I think this is having as much of an effect on my fitness and relationship with my body as anything else” (participant details not provided) | Buckley et al. (2021) | ||
| 2.2 Positive outcomes of the COVID‐19 pandemic | “Binging […] and purging has reduced. I was doing this five times a day. Now people are home with me my binge purge has reduced to every other day” (participant details not provided) | Branley‐Bell and Talbot (2020) | |
| “Your immune system is really weakened because of an ED [eating disorder] and for me, I do not want that anymore so I'm feeling really motivated to kind of improve my physical health as much as possible” (participant details not provided) | Clark Bryan et al. (2020) | ||
| “But I very quickly was able to turn it around and make it an opportunity for healing and like, I've dedicated so much time to eating disorder recovery during quarantine that I felt like that's what it was for. […] And so, I literally like am living in this renaissance of intuitive eating and of like, anti‐diet‐culture activism, because I found so much space for it during quarantine” (female participant) | Stoddard et al. (2021) | ||
| “Having the space to do that [reflect on recovery] is really good but I definitely did think that I was further along in my recovery than I am, but I guess that is a good thing because it means yeah I guess it is a good thing because it means I am aware of it as well which is helpful” (29, female participant, anorexia nervosa) | Hunter and Gibson (2021) | ||
| 3. Factors associated with body image and disordered eating outcomes | “I'm furloughed so have had the mental space to acknowledge that I do actually have a problem. I have started recognizing my own ED [eating disorder] thought patterns and behaviors and am working on challenging them” (participant details not provided) | McCombie et al. (2020) | |
| “My symptoms have probably gotten better because I am home and cannot go anywhere. Before my binge episodes were on the road and I was by myself. The fact that I am physically constrained and do not have access to what I had before helps. I do not go out much, not by myself. I am with my kids and family, so I do not have privacy and am very conscious of that” (participant details not provided) | Frayn et al. (2021) | ||
| “I am also a lot more honest with my family and friends about the struggles I face so I have constant support from them when I need it” (female participant, anorexia nervosa) | Vuillier et al. (2021) | ||
| “[Messages were] about not ‘letting oneself go’ or how terrible it would be to gain weight in quarantine, or how people were supposed to work hard to somehow come out of this ‘better than ever’, and boy, did the ED [eating disorder] voice in me love that” (White, bisexual, genderfluid participant) | Quathamer and Joy (2021) | ||
| “COVID‐19 has brought back many of the habits I had when I was struggling with my ED [eating disorder]. The spread of the jokes about the ‘corona 15′ were what sparked a lot of the unhealthy habits resurfacing” (22, female participant, White) | Simone et al. (2021) | ||
| “My mom had always joked about my body/weight (since I used to be overweight, she would joke about me not being able to fit through my door). She does not mean any harm, but I get really devastated when she mentioned that I've gained weight during quarantine. I started to restrict even more” (participant details not provided) | Nutley et al. (2021) | ||
| “I'm trapped at home with people who do not know I have anorexia. I am hiding and lying constantly” (participant details not provided) | Branley‐Bell and Talbot (2020) | ||
| It has meant that I have no one around to keep an eye on me so I can binge when I want to and then make myself sick to make myself feel better and I do not have to explain it to anyone because there is no one there to hear me” (male participant, bulimia nervosa) | Vuillier et al. (2021) | ||
| “It's a very secretive disorder and if I'm face to face with someone [for treatment] I cannot lie, I cannot hide the fact that I've lost weight or hide the fact that I'm drained energy‐wise, whereas on the phone I can cover up” (29, female participant, anorexia nervosa) | Hunter and Gibson (2021) | ||
| 4. Unique challenges for marginalized and underrepresented groups | “I was always concerned about how I look externally but ever since the pandemic the focus has been so much more because the way I justify it is I have more time to work on my body” (South Asian, gay, cisgender man) | Quathamer and Joy (2021) | |
| “I found myself snacking more than usual. Some days I would overeat, other days I would barely eat anything. The major concern has always been my weight. So that's something I'm looking forward to, like getting back on track with the whole, exercising, and trying not to snack as much as before” (Latina, pansexual, cisgender woman) | Tabler et al. (2021) | ||
| “I relished the opportunity to be comfortable at home so much and to not have to feel like I was presenting my body and gender in a socially acceptable way. I loved eating things that gave me pleasure without fear of outside judgment and connecting with my body through exercise in a slow and easy way” (White, bisexual, genderfluid participant) | Quathamer and Joy (2021) | ||
| “The pandemic made me stay with my unaccepting parents who do not respect my identity and limited my presentation to ways that made me feel very dysphoric and negative about my body” (White, lesbian, transgender woman) | Quathamer and Joy (2021) | ||